SENATE GIVES FINAL PASSAGE TO BILL TO ENSURE INDIVIDUALS WITH AUTISM RECEIVE INSURANCE COVERAGE FOR TREATMENTS AND THERAPIES

Senator Dean Skelos today announced that the state Senate has givenfinal legislative passage to legislation to ensure individuals withautism are able to receive insurance coverage for applied behavioralanalysis (ABA) therapy as intended under New York State’s autism insurancereform law.

The legislation is in response to regulations implemented by the NewYork State Department of Financial Services which have dramatically limitedthe number of ABA practitioners where individuals with autism can receivetherapy which is covered by insurance.

“When we enacted the autism insurance reform law it was intended toprovide coverage for families who were spending thousands of dollars fortheir loved ones to receive therapies and treatments for autism,” SenatorSkelos said. “However, many families did not get the coverage they neededdue to regulations that were contrary to the law’s intent. This newmeasure will ensure that people with autism get the coverage they werepromised, and that they need, just as the original law intended.”

Under New York’s autism insurance reform law, insurance companiesmust provide coverage for the screening, diagnosis, and treatment of autismspectrum disorders, including applied behavioral analysis (ABA), one of themost widely used autism therapies. Additionally, insurance companiescannot terminate coverage or refuse to renew, adjust, amend, issue, orexecute a policy solely because the individual has been diagnosed with orreceived treatment for autism spectrum disorders. The law was designed tohelp families who were spending tens of thousands of dollars out of pocketeach year on treatments and therapies for their loved ones with autism thatmany insurance companies refused to cover.

The law directed the New York State Department of Financial Services(DFS), in consultation with the Departments of Health and Education, topromulgate rules and regulations as to what qualifications a provider musthave in order to qualify for coverage, but clearly specified thatcertification by the national Behavior Analyst Certification Board would besufficient to receive coverage for ABA services. Instead, DFS implementedregulations requiring ABA practitioners to be licensed in order to qualifyfor insurance reimbursement, even though no such license exists in New YorkState.

As a result, only behavior analysts who have another type of statelicense, such as a physician or psychologist, and performs ABA therapywithin the normal scope of their duties can currently qualify for insurancereimbursement. This significantly limits the number of available providerswhere families can go to receive insurance-covered ABA therapy and forcesmany to still pay for this therapy out of pocket, contrary to the law’sintent.

The bill (S4862B) would establish a state license for behavioranalysts and allow those behavior analysts who are already certified by thenational Behavior Analyst Certification Board to immediately be licensedupon their filing an application with the state and paying a licensing fee.This would greatly expand the places where individuals with autism couldaccess the care they need and have it covered by insurance, as the lawintended.

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